Ethnic inequalities in access to WASH in Bangladesh
Authors: Md Zakiul Alam
Journal: The Lancet Global Health (2022)

The human right to water, sanitation, and hygiene (WASH) is at the core of Sustainable Development Goal (SDG) 6 (clean water and sanitation) and indirectly related to SDGs 3 (good health and well-being) and 10 (reduced inequalities).1World BankReducing inequalities in water supply, sanitation, and hygiene in the era of the sustainable development goals: synthesis report of the WASH Poverty Diagnostic Initiative. International Bank for Reconstruction and Development, Washington, DC2017https://openknowledge.worldbank.org/bitstream/handle/10986/27831/W17075.pdf?sequence=5&isAllowed=yDate accessed: December 31, 2021Crossref Google Scholar Sufficient, safe, culturally acceptable, physically accessible, and affordable water and sanitation facilities should be available without discrimination. WASH also became important in response to the COVID-19 pandemic as one of the main measures of protection in Bangladesh.2Islam SMDU Mondal PK Ojong N et al.Water, sanitation, hygiene and waste disposal practices as COVID-19 response strategy: insights from Bangladesh.Environ Dev Sustain. 2021; (published online Jan 2.)https://doi.org/10.1007/s10668-020-01151-9Crossref Scopus (17) Google Scholar Tribal people and minority ethnic groups comprise 1·1% of Bangladesh's total population.3Roy RD People's Republic of Bangladesh. Dhaka.https://www.ifad.org/documents/38714170/40224860/bangladesh_ctn.pdf/ea8bae36-7450-447a-b0e9-4c010ba315bfDate: 2012Date accessed: December 31, 2021Google Scholar Their residence is divided into "indigenous peoples of the Chittagong Hill Tracts" with at least 11 indigenous groups and "'indigenous peoples of the plains" with at least 21 indigenous groups.3Roy RD People's Republic of Bangladesh. Dhaka.https://www.ifad.org/documents/38714170/40224860/bangladesh_ctn.pdf/ea8bae36-7450-447a-b0e9-4c010ba315bfDate: 2012Date accessed: December 31, 2021Google Scholar Many minority ethnic groups are deprived of fundamental socioeconomic rights and experience discrimination, land extortion, ethnic prejudice, poor health, and poor nutritional status.3Roy RD People's Republic of Bangladesh. Dhaka.https://www.ifad.org/documents/38714170/40224860/bangladesh_ctn.pdf/ea8bae36-7450-447a-b0e9-4c010ba315bfDate: 2012Date accessed: December 31, 2021Google Scholar Although in Bangladesh 23·2% of the population lives below the national poverty line and 67·9% is literate, some of the hardcore poor people are found among minority ethnic groups, with 70% of minority ethnic households (ie, twice the national average) earning less than the minimum food requirements set for Bangladesh.3Roy RD People's Republic of Bangladesh. Dhaka.https://www.ifad.org/documents/38714170/40224860/bangladesh_ctn.pdf/ea8bae36-7450-447a-b0e9-4c010ba315bfDate: 2012Date accessed: December 31, 2021Google Scholar The educational situation among minority ethnic groups is quite poor, with only 9% being literate and 2% having completed secondary education.3Roy RD People's Republic of Bangladesh. Dhaka.https://www.ifad.org/documents/38714170/40224860/bangladesh_ctn.pdf/ea8bae36-7450-447a-b0e9-4c010ba315bfDate: 2012Date accessed: December 31, 2021Google Scholar Fewer data are available for these minority ethnic groups than for the Bengali population, which is a form of discrimination, because researchers and the Bangladeshi Government are not including these groups in their work or policies. These factors together create inequalities in access to WASH among minority ethnic groups and the Bengali population (figure). Access to improved drinking water sources is almost universal for the Bengali population, whereas only 61% of the minority ethnic population has such access. Almost 24% of households among minority ethnic groups have drinking water on premises free from Escherichia coli, compared with 48% of Bengali households. The proportion of households with handwashing facilities where water and soap are available is 75% for Bengali households and 50% for minority ethnic households. The proportions for improved sanitation are 85% for Bengali households and 50% for minority ethnic households. The proportion of women using menstrual hygiene materials is 94% for Bengali women and 79% for women from minority ethnic groups.4Bangladesh Bureau of StatisticsUNICEF BangladeshProgotir Pathey Bangladesh multiple indicator cluster survey 2019, survey findings report. Bangladesh Bureau of Statistics, Dhaka2019https://www.unicef.org/bangladesh/media/3281/file/Bangladesh 2019 MICS Report_English.pdfDate accessed: June 24, 2021Google Scholar A study conducted in the Chittagong Hill Tracts also found similar inequalities among minority ethnic groups in the region.5Mahmud MS Amin SMA Rashed MAW Mahmud R Water, sanitation and hygiene practices among ethnic communities in Chittagong Hill Tracts, Bangladesh.Int J Curr Res. 2020; 12: 13269-13275Google Scholar The situation of WASH in the Chattogram division is near to the national average. In the Chittagong Hill Tracts region, which is a group of districts within the Chattogram division, 91% of the Bengali population has access to improved water sources, whereas only 52% of people from minority ethnic groups have such access.4Bangladesh Bureau of StatisticsUNICEF BangladeshProgotir Pathey Bangladesh multiple indicator cluster survey 2019, survey findings report. Bangladesh Bureau of Statistics, Dhaka2019https://www.unicef.org/bangladesh/media/3281/file/Bangladesh 2019 MICS Report_English.pdfDate accessed: June 24, 2021Google Scholar Similar disparities are also observed regarding the availability of handwashing facilities and the use of menstrual hygiene materials. In the plains, the Bengali population has improved access to WASH compared with minority ethnic groups. The inequality in access to WASH among minority ethnic groups and the Bengali population is an aftermath of structural racial discrimination in Bangladesh, where micro-level systems, social factors, institutions, ideologies, policies, and processes contribute to unfairness against minority people.6Williams DR Lawrence JA Davis BA Racism and health: evidence and needed research.Annu Rev Public Health. 2019; 40: 105-125Crossref PubMed Scopus (770) Google Scholar Very few laws are associated with minority ethnic people in Bangladesh. Most of these laws apply to the Chittagong Hill Tracts region.3Roy RD People's Republic of Bangladesh. Dhaka.https://www.ifad.org/documents/38714170/40224860/bangladesh_ctn.pdf/ea8bae36-7450-447a-b0e9-4c010ba315bfDate: 2012Date accessed: December 31, 2021Google Scholar Concerning WASH, minority ethnic people are inadequately represented in policies in Bangladesh. Minority ethnic groups are not mentioned in the National Strategy for Water Supply and Sanitation 2014,7Local Government DivisionNational strategy for water supply and sanitation 2014. Ministry of Local Government, Rural Development and Cooperatives, Government of the People's Republic of Bangladesh, Dhaka2014https://www.psb.gov.bd/policies/nswsse.pdfDate accessed: May 22, 2022Google Scholar the National Strategy for Water Supply and Sanitation 2021,8Local Government DivisionNational strategy for water supply and sanitation: revised and updated edition 2021. Ministry of Local Government, Rural Development and Cooperatives, Government of the People's Republic of Bangladesh, Dhaka2021https://www.psb.gov.bd/policies/nswssren.pdf?fbclid=IwAR1Epe26uNOPpX17a86t8kShjcl2SefQuX07B1Gvo_oFSwk771IixOIpOvwDate accessed: January 30, 2022Google Scholar and the fourth Health, Population, and Nutrition Sector Program (HPNSP) of Bangladesh. To my knowledge, most of the strategies to date mentioned specific approaches for hard-to-reach areas and vulnerable populations (eg, elderly, women, and children), in which indigenous population is not explicitly included.8Local Government DivisionNational strategy for water supply and sanitation: revised and updated edition 2021. Ministry of Local Government, Rural Development and Cooperatives, Government of the People's Republic of Bangladesh, Dhaka2021https://www.psb.gov.bd/policies/nswssren.pdf?fbclid=IwAR1Epe26uNOPpX17a86t8kShjcl2SefQuX07B1Gvo_oFSwk771IixOIpOvwDate accessed: January 30, 2022Google Scholar The only strategy that has taken account of the indigenous population is the National Hygiene Promotion Strategy for Water Supply and Sanitation Sector in Bangladesh 2012.9Local Government DivisionNational hygiene promotion strategy for water supply and sanitation sector in Bangladesh 2012. Ministry of Local Government, Rural Development and Cooperatives, Government of the People's Republic of Bangladesh, Dhaka2012https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/2012_lgd_nationalhygienepromotionstrategywss.pdfDate accessed: January 30, 2022Google Scholar Additionally, Bangladesh's strategic paper for WASH issues during COVID-19 did not mention indigenous people and only discussed strategic plans for the Chittagong Hill Tracts. The Bangladesh National Health Policy 2011 does not mention inequality among minority ethnic groups, nor any specific actions.10Murshid M-E Haque M Hits and misses of Bangladesh National Health Policy 2011.J Pharm Bioallied Sci. 2020; 12: 83-93Crossref PubMed Scopus (4) Google Scholar Minority ethnic groups experience direct discrimination because of the laws, policies, or practices that exclude them from equal service provision or treatment (eg, reduced access to safe drinking water). Moreover, indirect discrimination results in their inequity in access to WASH due to their poor socioeconomic condition and geographical location. Structural racism affects the larger social environment, leading to health inequalities for minority ethnic groups. Long-lasting and robust policy actions need to be taken to eliminate this discrimination,6Williams DR Lawrence JA Davis BA Racism and health: evidence and needed research.Annu Rev Public Health. 2019; 40: 105-125Crossref PubMed Scopus (770) Google Scholar and should include the Bangladeshi Government as the primary bearer for the human right to WASH. To reduce inequality, the determinants need to be identified, and more scientific and empirical studies, laws, practices, and programmes should be directed accordingly. Targets should be set first to achieve basic services for all; publicly available disaggregated data should be made available with a specific time interval as the SDGs have explicitly focused on leaving no one behind. Together, these initiatives will reduce inequality and ensure coverage and quality of WASH services for minority ethnic groups in Bangladesh. I declare no competing interests.